Yea or Nay? See Which QPP 2018 Proposals Came Through in the Final Rule

Thu, Dec 14, 2017


yes or no for QPP proposals

Back in July, TCI SuperCoder blog had a post about the proposed 2018 Quality Payment Program (QPP) rule, a program established under MACRA. Now that the final rule (with comment period) is out, let’s see how some of those proposals fared.

Small Provider Exemption/Low-Volume Threshold

Proposal: The proposed rule included adjusting the 2017 low-volume threshold of $30,000 in Medicare Part B allowed charges, or 100 or fewer Part B patients, to a new 2018 level of $90,000, or 200 or fewer Part B patients. …

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Compare and Contrast 94620 and Its Replacement Codes for Pulmonary Testing

Fri, Dec 8, 2017


pulmonary testing

Pulmonology coders are saying goodbye to a common pulmonary stress testing code on Jan. 1, 2018. Here’s what’s replacing it, along with some Medicare Physician Fee Schedule details to help you get a better handle on the new codes.

Compare the Code Descriptors

In 2017, you use 94620 (Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry)) for simple pulmonary stress testing.

For dates of service of Jan. 1, 2018, and later, you’ll use these Continue reading...

Can’t-Miss Corrections to CPT® 2018 Available Now!

Mon, Dec 4, 2017


Don't miss CPT 2018 corrections

Time to bring out the red pen and take your CPT® 2018 preparations to the next level! Every detail counts in coding, and that means that after you’ve taken a look at the initial announcements about code changes, you need to dig deeper to make sure you’re aware of corrections, too. The AMA released several corrections you’ll want to be sure you note in your 2018 manual if you’ve got a hard copy. And when the code set is implemented on Jan. 1, 2018, confirm that your online coding resources have …

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Know What’s New for Neuro Coding in CPT® 2018

Thu, Nov 30, 2017


CPT 2018 update TENS coding

Nerve repair, neurostimulators, and visual evoked potential testing all face some changes when CPT® 2018 becomes effective Jan. 1, 2018. Give your neurology and neurosurgery coding prep a jumpstart with these tips.

Watch for Allograft Nerve Repair Option

If your practice is on the cutting edge and using nerve allografts for repair, you’ll need to know these two new codes:

  • 69412 (Nerve repair; with nerve allograft, each nerve, first strand (cable))
  • +69413 (… with nerve allograft, each additional strand (List …
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Home in On the Details in 2018 Ob-gyn Coding

Tue, Nov 21, 2017


Most ob-gyn coders know the mantra—specificity, specificity, specificity. If you want prompt and ethical reimbursement in 2018, though, specificity just got real. Are you up to date on the changes now in effect?

Pick a Side with New Sixth Character for Tubal and Ovarian Pregnancies

CMS provided some much-needed updates to tubal and ovarian pregnancies with and without intrauterine pregnancy. Lateral status, historically absent in the code description, is now indicated in a new sixth character:

Deletion of O00.10 (Tubal pregnancy without intrauterine pregnancy)

  • Addition of O00.101 (Right tubal pregnancy without intrauterine pregnancy)
  • Addition of O00.102 (Left tubal pregnancy without intrauterine pregnancy)
  • Addition of O00.109 (<...
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Medicare Open Enrollment: What’s New for 2018?

Tue, Nov 14, 2017


It’s that time of year again — time for your patients to start thinking about their healthcare needs and what they’re looking for in their Medicare health and drug plans. Medicare Open Enrollment began on Oct. 15 and will remain open until Dec. 7. And there’s good news. CMS reports more options and lower premiums in 2018, which means your patients should be able to find plans that cost them less and give them more.

This year’s lineup includes the addition of 400 Medicare Advantage plans from which your patients can choose, with greater than 85 percent of Medicare recipients having access to ten or more Advantage plans. Monthly premiums for the average Medicare Advantage will decrease by almost $2.00, reducing the average cost by about 6 …

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5 Fast Facts About 1 Payer’s 50 Percent Fee Reduction for Modifier 25

Mon, Nov 6, 2017


50 percent pay cut

A payer’s big modifier 25 payment reduction has been getting a lot of attention, both from providers affected and those concerned other payers will adopt the policy. Don’t miss this overview of what the policy is all about.

1. Which Payer Implemented the Policy?

Independence Blue Cross, which primarily serves Philadelphia and southeastern Pennsylvania, updated its commercial policy and Medicare Advantage policy related to modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service).

2. When Is the Policy Effective?

The policy changes went into effect …

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‘Hoo’ Is Performing Photodynamic Therapy? CPT® 2018 Says You’d Better Know

Tue, Oct 31, 2017


Happy Halloween!

Hope you can forgive that bit of Halloween headline fun before we get down to serious coding business! Maybe “‘Witch’ Team Member” would have been more to your liking than “Hoo.” Either way, I bet you are ready for more CPT® 2018 news now. Here’s what you need to know about the photodynamic therapy update swooping our way Jan. 1.

The procedure: Photodynamic therapy services involve using a photosensitive agent at one or more target areas and then applying a special light to activate the agent. The activation by the light results in a special kind of oxygen that destroys certain cells.  An example service would be removal of a lesion from an eyelid.

Kick Things Off With …

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INR Monitoring Code Changes Coming (But Old Faves Could Stick Around, Too)

Thu, Oct 19, 2017


patient training

If you code for anticoagulant management — and a lot of folks do — you’ll need to get a handle on some changes headed our way when CPT® 2018 is effective on Jan. 1, 2018. Here’s the scoop.

Let’s Start With What’s In and What’s Out for CPT®

Out: In CPT® 2018, these two codes will be deleted:

  • 99363 (Anticoagulant management for an outpatient taking warfarin, physician review and interpretation of International Normalized Ratio (INR) testing, patient instructions, dosage adjustment (as needed), and ordering of additional tests; initial 90 days of therapy (must include a minimum of 8 INR measurements))
  • 99364 (… each subsequent 90 days …
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For World Anesthesia Day, Here’s What’s New in CPT® 2018 for 00000-Range Codes

Fri, Oct 13, 2017


CPT 2018 changes for anesthesia

October 16 is World Anesthesia Day because the first successful demonstration of ether anesthesia occurred on that date in 1846. Boston dentist William Morton administered the ether to a patient undergoing removal of a neck tumor. Mark me down in the glad-anesthesia-is-available column.

In honor of World Anesthesia Day on Monday, let’s look at what’s new for anesthesia in CPT® 2018. If you code anesthesia for GI procedures, neurectomy, or shoulder cast application, there’s some news you need to know.

Get Ready for These GI Changes

In 2017, you …

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